Altitude related illness
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Transcript of Altitude related illness
Altitude Related Illness
Steven Podnos MD
Definition
• A multitude of medical problems are associated with ascent to altitude, ranging from minor to life threatening
• Hypoxia is considered a causative feature, but other elements of causation are uncertain
Syndromes
• Minor-impaired sleep• Major:• Acute Mountain Sickness (AMS)• High Altitude Pulmonary Edema (HAPE)• High Altitude Cerebral Edema (HACE)
AMS
• Almost universal with rapid ascent• Vague and inconsistent symptom complex:• Poor sleep, irritability, Headache, Dyspnea, GI
symptoms, Dizziness
AMS Factors
• Individual susceptibility• Altitude over 7000 feet• Rapid ascent• Pathophysiology –theory- hypoxia leads to
increased Cerebral Blood Flow, then edema due to hydrostatic pressure and capillary leak
AMS-Treatment
• Slow careful ascent prevents AMS• Acclimatization at an altitude or slight descent
helps• O2 resolve symptoms• Acetazolamide (Diamox)-125-250mg BID
begun one day before ascent and continued for two more days is effective
• Steroids are effective-prevention and Rx
HAPE
• 1-3 days after ascent• Cough, SOB, fatigue, can have bloody sputum• Signs: fever, rales, cyanosis• Hypoxia, tachycardia, tachpnea• Cause unclear-may be result of focal
hyperperfusion of PAs
HAPE-Rx
• Descent 1-3K feet very effective• O2• Hyperbaric bags
HACE
• Severe AMS• Mental Status Changes/Ataxia• Leads to severe impairment /death• May be rapidly progressive, even during sleep• Usually occurs after a few days at altitude
HACE Rx
• Rapid descent• O2• Steroids• Hyperbaric bag
Special Problems with Altitude
• CAD-slightly increased risk of exercise induced ischemia.
• COPD-mild increased symptoms (? Used to hypoxia), mild increased long term mortality
• Asthma-cold dry air is a trigger, but reduced allergens and reduced air density are helpful
• Sickle Cell disease-avoid altitude-even planes